Gallstones

Gallstones are a frequent cause of troubles, especially in women. They are located in gallbladder, but they may get stuck in the bile duct causing painful condition. They have a close relationship to cholecystitis and probably also to the gallbladder cancer.

 

The gallbladder is a hollow organ that is both anatomically and functionally closely related to the liver. Gallbladder is used for storage of produced bile. After we eat food, the gallbladder contracts due to effect of certain hormones and expels the bile through bile duct into the intestine.  The bile contains certain waste products that can be excreted out of the body and in addition, it is important for proper digestion of food. Bile in the intestine is mixed with pancreatic digestive enzymes and helps to activate them. Bile also serves to disperse fat particles and makes them much easier to digest.

 

Gallstones have different sizes (the smallest are known as biliary sand), shapes and colors. Most of them are made ​​up of cholesterol and these have yellow color. Rarely, black pigmented stones may also occur.

Causes

There are many risk factors of gallstones including age, sex, diet rich on cholesterol and low on dietary fiber. Women are more often affected than men. Typical patient is an overweighed or obese woman with high level of cholesterol. It is quite logical – excessive amount of cholesterol in body is followed by excessive excretion of cholesterol into the bile and increases risk of formation of cholesterol gallstones. The risk is reported to be higher in users of hormonal contraception and in pregnant women due to higher levels of sex hormones.

 

Black pigment stones are formed by bilirubin and calcium salts. They accompany situation with higher excretion of bilirubin. Bilirubin is a decay product of hemoglobin, which is a pigment located within red blood cells. Therefore, increased amount of bilirubin is related to higher disintegration of erythrocytes.

Gallstones

 

Symptoms

The gallstones may cause no symptoms; they are just present in the gallbladder. However, there are numerous complications of gallstones’ presence and they are named below, separately.

Diagnosis

The gallstones can be quite easily diagnosed by abdominal ultrasound. Other examination methods that are used in case of gallstones complications can be found in related texts.

Complications

Biliary colic

The condition occurs when a part of the biliary tract gets blocked by a gallstone. The local muscles try to move the obstacle causing very unpleasant colic pain. This abdominal pain is located in the right upper abdominal quadrant. Unless the situation is not solved spontaneously or by a medical intervention, there is a high risk of acute cholecystitis or acute cholangitis.

Acute pancreatitis

Acute pancreatitis can occur when the gallstones block bile duct under its connection with pancreatic duct. The obstruction prevents both bile and pancreatic juice to flow into the intestine. The both accumulated fluids mix and digestive pancreatic enzymes get activated prematurely. The resulting digestive process may damage the pancreas itself causing biliary acute pancreatitis. The best way of treatment is ERCP with removal of the blocking stone.

Cholecystitis

The gallstones may decrease (or totally disrupt) the outflow of bile from the gallbladder. When bacteria enter the accumulated bile, it can cause the acute cholecystitis.  Acute cholecystitis manifests with abdominal pain located in the right upper abdominal quadrant and with fever. Long-term presence of gallstones can cause chronic inflammation of gallbladder’s wall (chronic cholecystitis). This manifests rather with unspecific digestive problems and mild abdominal pain. Untreated chronic cholecystitis may lead to porcelain gallbladder and to gallbladder cancer.

Acute cholangitis

This is a dangerous condition where the bile duct is infected by bacteria from the gut. Acute cholangitis manifests with abdominal pain in the right upper abdominal quadrant, high fever and chills. It must be treated by antibiotics.

Porcelain gallbladder

This condition arises in long-term presence of the gallstones that cause chronic inflammation of gallbladder. The condition is accompanied with deposition of calcium salts in the gallbladder’s wall, which hardens – therefore the name “porcelain gallbladder”. Porcelain gallbladder is related to higher risk of gallbladder cancer (see below) and should be surgically removed.

Gallbladder cancer

This can be a consequence on long-term untreated gallstones that cause chronic irritation and inflammation of the gallbladder wall. It should be noted that gallbladder cancer is an extremely dangerous form of tumor.

Intestinal obstruction

This is a less frequent complication, which happens when a larger gallstone gets out of the gallbladder into the bile duct, somehow passes through and gets to the intestine, where it causes an obstruction. The situation is referred to as mechanical ileus. It must be solved surgically by removing the stone. More information can be found in text dedicated to mechanical ileus.

Treatment

Gallbladder stones can be treated either conservatively, or surgically. There are medications that may be used to dissolve the stones, but their results are somehow controversial. They may be efficient when used regularly long-term and against small stones.

 

Surgery aims to remove the entire gallbladder (cholecystectomy) with the gallstones. It is possible as the gallbladder is not a vital organ. However, it is important to know that after the removal of gallbladder, the patient is no longer able to digest fats as effectively as before. It is advisable not to eat large amount of fatty food as the fats may stay undigested and cause diarrhea with oily, fatty and smelly stool.

 

The surgical approach may be either laparoscopic or laparotomic (opening the abdomen by one large opening). In modern time, the laparoscopic approach is usually preferred. Laparoscopic cholecystectomy is a procedure that leaves only small scars and significantly shortens the period of hospitalization. The wall of the removed gallbladder should be examined histologically to rule out presence of any incidental gallbladder cancer.